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MONDAY, July 2, 2012 — Na (salt) plus H2O (water, but frozen) equals a chemical reaction that has been sending some teens to the emergency room.

Applying ice and salt to skin and leaving it there even for a short while — something called the "salt-and-ice challenge" — can lead to a painful and potentially dangerous burn. That hasn't deterred hundreds of kids from trying it out.

YouTube is full of videos showing the challenge, in which kids apply salt to their skin, then press an ice cube on top. The resulting chemical reaction almost immediately begins to burn the skin, with the "challenge" being to keep going as long as possible despite the pain.

Last weekend, a 12-year-old Pittsburgh, Pa. boy ended up with a bloody, blistered, gruesome cross-shaped burn on his back after trying out the salt and ice challenge with his twin brother and a friend.

"The injury is similar to frostbite," said Ariel Aballay, MD, at a press conference. Dr. Aballay is director of the West Penn Burn Center in Pittsburgh, where the boy was treated for second-degree burns. Aballay added that the longer the ice and salt are left on the skin, the more serious the possible injury. But even a few minutes is enough to produce red, painful blisters.

Dangerous Teen Fads: What Are They Thinking?

The salt-and-ice challenge is the most recent popular — and scary — teen fad to hit the headlines of late. Other recent examples include the choking game, where kids choke or strangle themselves to the point of passing out, and the cinnamon challenge, which involves swallowing a tablespoon of the powdered spice without water and can cause choking.

What's behind all this risky behavior? "Sometimes it's peer pressure, sometimes a sense of bravado," says Andrew Adesman, MD, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park. "Sometimes kids need to be accepted or stand out among their peer group. Even smart kids do stupid behaviors."

And while the teen fads of years gone by — think goldfish swallowing — took much longer to catch on, today's kids have only to turn on their laptops or look at their smartphones to find out about the latest trend. "It spreads much more quickly," says Dr. Adesman. "The numbers suggest that this is not just a small number of kids in part of the country. Everyone's got salt and ice at their disposal."

But some "challenges" are riskier than others. "Kids will purposely engage in a behavior that they presume to be more thrilling than dangerous," says Adesman. "But in this case, it's such a predictable consequence. Hopefully none of these same kids would think, 'How long can I leave my finger on a hot burner?' "

Salt-and-Ice Challenge: What Parents Can Do

According to news reports, some school officials have been sending letters to parents about the dangers of the salt-and-ice challenge, but many others may be unaware of this new fad.

"What's striking about this case is that they decided to do something proactive about it," Adesman notes. "You can be sure this isn't the first time kids got hurt."

The mother of the injured Pittsburgh boy told the Post-Gazette that she wants parents to be more aware of the various challenges on Facebook, YouTube, and elsewhere. "Kids are so impressionable and you can tell them no until you are blue in the face." Her son's back could take several months to heal and requires treatment with topical creams four times a day.

"You can't take salt and ice out of the house," says Adesman. He suggests that parents use the graphic photo of the Pittsburgh boy's burn (see above) as a learning tool. "If they have middle-school kids or high-school kids, showing them that picture can be a wakeup call. You can have disfiguring scars from that type of injury."

Do you think your teenager would try something like this? Why or why not? Share your response in the comments below — thanks!

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